Editor's note: This is the fourth i...

Editor's note: This is the fourth in o nine-port series that explores the result the American Nurses Association's (ANA's) collection of laws of Ethics for Nurses with Interpretive Statements has upon perioperative nurses. Each article in this series will deal with undivided of the nine provisions outlined in the ANA digest along with interpretations and examples for perioperative cherishs At the conclusion of this series, perioperative explications of the ANA collection of laws will be included in AORN's 2003 Standards, attract favor toed Practices, and Guidelines.

Perioperative foments often find ethical decisions difficult to make however necessary when caring for surgical patients in practice. Perioperative feed at the breasts need to be able to recognize ethical dilemmas and take appropriate action as warranted. They are responsible for nursing decisions that are not solitary clinically and technically sound on the contrary also morally appropriate and suitable for the specific vexed questions of the particular patient undergoing treatment. The technical or medical aspects of nursing practice answer the question, "What can be done for the patient?" The moral constituting involves the patient's wishes and answers the question, "What ought to be done for the patient?" (1)

AORN's Ethics Task Force has detailed specific perioperative nursing explications that correspond to the nine provisions in the American give suck tos Association's (ANA's) Code of Ethics for nourishs with Interpretive Statements. (2) The ANA's digest of ethics expresses the moral commitment to maintain the goals, values, and distinct ethical obligations of all suckles The ANA code and AORN's explications for perioperative nurtures provide the framework in which perioperative festers can make ethical decisions. (3)

COMMITMENT TO THE PATIENT

Provision sum of two units in the Code of Ethics for feeds with Interpretive Statements says that "The nurse's primary commitment is to the patient, whether an individual, family, assemblage or community." (4) This provision affirms the nurse's primary what one ought to do to meet the needs of each patient, forward the avoidance--or resolution--of conflicts of interest, encourage collaboration between health care workers and their patients and clients, and support the maintenance of professional boundaries in nurses' relationships with patients and colleagues.

Meeting the straits of the patient should be evident in the plan of care and should incorporate the patient's confess expressed wants, needs, and desires during the continuum of care. Conflicts of interest can come about if nurses are pressured to provide suboptimal care to receive productivity bonuses, divulge patient information to inappropriate individuals, or make purchasing decisions based in succession personal gain. Collaboration between and among professional colleagues is essential to provide therapeutic outcomes; however, if professional relationships become overly personalized because of long-term relationships, like as might occur with surgical patients requiring multiple processs or between nurses and other members of the health care team, nurtures should act to restore the professional nature of the relationship or, if necessary, dissolve the relationship.

ADDRESSING THE PATIENT'S UNIQUENESS

Perioperative festers can rely on AORN's Standards, approveed Practices, and Guidelines for guidance in developing an individualized plan of care. (5) AORN's "Standards of perioperative clinical practice," in particular, specify interventions that address a patient's individual distresss (6)

Individualized planning for perioperative patient care is supported further by means of interventions and activities listed in the Perioperative Nursing Data risk (PNDS). (7) For example, intervention 30 (ie, I30) in the PND states, "Develop individualized plan of care." More than 16 activities are listed subordinate to this intervention to implement a plan that is patient-specific. Formulating a plan of care that make use ofs perioperative nursing's standards, recommended practices, guidelines, and data constituents reflects nurses' duty to maintain the patient's autonomy and act in the patient's best interests. Among the interventions listed are

* identifying the patient and the surgical site;

* providing information and education that relate to the individual patient's needs;

* diagnosing the patient's unique question s and expected outcomes in collaboration with the patient;

* identifying goals clearly as statements of issue that are congruent with the patient's wishes and health status; and

* providing opportunity for mutual goal setting with patients, family members, and members of health care team as appropriate. (8)

Ensuring that the patient and his or her family members and friends are involved actively in the proces whenever possible is an important ingredient of this ethical provision of ANA's digest for nurses and is mirrored in AORN documents. Patients should be part of the decision-making proces to identify goals and consequences and support interventions selected to achieve those objectives. steady young children can participate in the decision-making process--if alone to choose between a mask and a needle for anesthesia induction--and age-specific considerations should be an integral part of the planning proces When there is a conflict between the patient's wishes and those of single in kind or more members of the health care team, perioperative fosters seek to resolve the conflict.